Assesses hypermobility or instability of the atlantoaxial articulation.

  • Following trauma to the head and/or neck (e.g. car crash)
  • If there are signs and symptoms of upper cervical instability such as muscle spasm, radiating neurological symptoms, nystagmus, nausea, dizziness, or excessive movement

Patient Position
  • Supine
Examiner Position
  • At the patient's head
Steps of Performance
  • Support patient’s head with palms and 3rd through 5th digits
  • Place index fingers between occiput and spinous process of C2 (i.e. index fingers over neural arch of C1)
  • Lift patient’s head and C1 anteriorly without allowing flexion or extension
    • Hold for 10–20 seconds
Alternative Methods

The Transverse Ligament Stress Test challenges the atlantoaxial articulation by distributing tension through the transverse ligament of the atlas, allowing the practitioner to sense hypermobility.

General

Positives

Soft End-feel (i.e. ligament laxity)

  • Atlantoaxial Instability

Recurrence of Symptoms

  • Myelopathy
    • Common Symptoms: nystagmus, muscle spasm, dizziness, abnormal pupillary response, nausea, facial/lip/limb paresthesia, feeling of a lump in the throat

Pertinent Negatives

Hard End-feel

  • No joint instability

No Recurrence of Symptoms

  • Spinal canal patency

DATA
TAGS
References
Kaale BR, Krakenes J, Albrektsen G, Wester K. Clinical assessment techniques for detecting ligament and membrane injuries in the upper cervical spine region--a comparison with MRI results. Man Ther . 2008;13(5):397-403. doi:10.1016/j.math.2007.03.007
Hutting N, Verhagen AP, Vijverman V, Keesenberg MD, Dixon G, Scholten-Peeters GG. Diagnostic accuracy of premanipulative vertebrobasilar insufficiency tests: a systematic review. Man Ther. 2013;18(3):177-182. doi:10.1016/j.math.2012.09.009

Assesses hypermobility or instability of the atlantoaxial articulation.

  • Following trauma to the head and/or neck (e.g. car crash)
  • If there are signs and symptoms of upper cervical instability such as muscle spasm, radiating neurological symptoms, nystagmus, nausea, dizziness, or excessive movement

Patient Position
  • Supine
Examiner Position
  • At the patient's head
Steps of Performance
  • Support patient’s head with palms and 3rd through 5th digits
  • Place index fingers between occiput and spinous process of C2 (i.e. index fingers over neural arch of C1)
  • Lift patient’s head and C1 anteriorly without allowing flexion or extension
    • Hold for 10–20 seconds
Alternative Methods

The Transverse Ligament Stress Test challenges the atlantoaxial articulation by distributing tension through the transverse ligament of the atlas, allowing the practitioner to sense hypermobility.

General

Positives

Soft End-feel (i.e. ligament laxity)

  • Atlantoaxial Instability

Recurrence of Symptoms

  • Myelopathy
    • Common Symptoms: nystagmus, muscle spasm, dizziness, abnormal pupillary response, nausea, facial/lip/limb paresthesia, feeling of a lump in the throat

Pertinent Negatives

Hard End-feel

  • No joint instability

No Recurrence of Symptoms

  • Spinal canal patency